PEACE and LOVE
STOP using the RICE method! You need some PEACE and LOVE!
Pop Quiz! What should you do with an acute muscle/ligament injury, like a sprained ankle? (hint: it’s in the name of the blog)
Most people are going to tell you the age-old strategy Rest, Ice, Compress, and Elevate, or RICE for short. Some people might even recommend PRICE, which adds in Protect, using something like crutches to make sure you’re not putting any stress on that injured area whatsoever. The idea behind these strategies is to hopefully decrease pain and inflammation, decrease swelling, all in an effort to increase speed of healing. But, what if I told you that those things don’t necessarily speed things along as much as we think?
After an acute injury, our body starts a number of different processes to heal whatever injury has occurred. This results in 4 different phases of healing: Hemostasis, the Inflammatory phase, the Proliferative phase, and the Remodeling phase. Phase 1, Hemostasis, is most relevant when we have a cut, as it mostly pertains to stopping the bleeding through the formation of a scab, so this usually ends within moments. More important for our discussion today is phase 2, the Inflammatory phase. During this phase, we see a great deal of increased blood flow to the area to allow your body to clear out damaged tissue and bring new healthy ‘building block’ material to the area. Numerous different enzymes and hormones are rushed to the area to accomplish these tasks as quickly as possible, and it is expedited by the fact that blood flow to the damaged spot is much higher. This is when we see swelling, redness, and warmth in the area, due to this major increase in blood flow. Sounds like a pretty smart system, right?
This takes us back around to the RICE method for treating injuries. Above, we discussed how the intention with the RICE is to decrease swelling and inflammation of an acute injury. Specifically, using ice as part of RICE is intended to decrease swelling by decreasing blood flow through vasoconstriction. But we also just went through some of the mechanisms by which our bodies heal - through INCREASED blood flow! Obviously, these two are directly opposing one another! So why would we use ice to decrease swelling and blood flow, when our body’s natural response to heal an injury is to INCREASE swelling and blood flow? Multiple literature reviews suggest that icing after an injury either slowed down the healing process, or had no clear benefit.
So, if we are ditching the RICE method, what are we supposed to do? This is where we need to show ourselves some PEACE and LOVE.
Protect the area for the first few days, avoid painful activities
Elevate the area above the level of the heart
AVOID anti-inflammatories like ibuprofen, Aleve etc. and AVOID ice!
Compress the area with something like a sports bandage
Education: Your body knows best, avoid unnecessary treatments and let your body do what it does best!
Load: Start to return to normal activities and let your symptoms guide you.
Optimism! A positive mindset can ↓ pain and get you back to 100% faster.
Vascularization: aerobic exercise! Get the blood flowing while tissues heal
Exercise: Take an active approach - teach that healing tissue what it needs to be able to do by DOING IT!
Not only does PEACE and LOVE sound way cooler than RICE, but it gives us a much more comprehensive plan, covering what to do during all of the different phases of healing. So, next time you have an acute injury, you’ve got a much better idea of what to do to get back to doing what you love. Also, I hope by now you’ve figured out the answer to my pop quiz at the beginning!
Thanks for reading!
Jesse Brown, PT, DPT
Along with his education as a Doctor of Physical Therapy, Jesse brings an extensive background in exercise to the clinic. With experience across all different types of weight training, including Olympic-style weightlifting, CrossFit, and powerlifting, you can be sure that Jesse has the expertise to help you get where you want to go!
When he’s not helping individuals in the clinic, Jesse can be found practicing what he preaches - lifting the bar. He is an avid weightlifter, competing and refereeing locally through USA weightlifting.
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004 Jan-Feb;32(1):251-61. doi: 10.1177/0363546503260757. PMID: 14754753.
Collins NC. Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emerg Med J. 2008 Feb;25(2):65-8. doi: 10.1136/emj.2007.051664. PMID: 18212134.
Dubois B, Esculier JSoft-tissue injuries simply need PEACE and LOVEBritish Journal of Sports Medicine 2020;54:72-73.